The Problem of Schizophrenia and Social Class

Research has shown schizophrenia to be more common among people at the lower end of the social scale than at the upper. But is lower status the cause or the result of the disease? Dr. Thomas Arie of the London Hospital Medical College reviews the evidence and finds strong support for the view that schizophrenia brings about a downward drift. Schizophrenic patients occupy about one-seventh of all National Health Service beds, and it has been estimated that well over half of all the long-stay psychiatric patients suffer from schizophrenia. It is clear that, despite the great benefits which have come from the new drugs and social treatments, the burden of schizophrenia is still massive. In at least two respects, this burden is remarkably constant. One constant feature is that the individual risk of developing the disease (about one per cent) is strikingly uniform in different lands and different cultures. Another is that the disease is very unequally distributed between the different social classes, being much more common among members of the lower social classes than among the higher? among unskilled labourers than among professional men. In other words, the lower one looks in the socioeconomic scale, the more schizophrenia one finds. investigated the frequency of the disease in different districts, and found that schizophrenia rates were highest in the central 'downtown' areas where the poor, the vagrant and the solitary lived, often in lodging houses and rented rooms. From these central afeas, the rate followed a diminishing gradient out to the settled, residential suburbs, where it was lowest. This pattern has been found in other American studies, and in this country by Dr. E. H. Hare in Bristol. Once this striking relationship with environment had heen discovered, other workers looked at the disease in relation to 'social class' (in this country, the Registrar General's index is based on occupation). Here, t?o, the findings have generally shown a gradient, which has its peak among the lowest social classes. Various suggestions have been made to explain away the class gradient as due to bias in diagnosis by doctors. It has been suggested that they may be very reluctant to diagnose the disease in professional men, as compared with unskilled labourers, both because ?f cultural barriers to effective communication between the doctor and his working class patients, and because the effect of the diagnosis might be more serious for a man in a …